Complete this request with information
from all containers to be picked up.

Use this form for up to 5 containers
at a time. If you have more than 5, submit more than one form, or
use the fax form.

Remember to complete and sign the tag
on the full containers in your lab. Also be sure to note the results
of the contamination survey on the tag. If any of these items
are incomplete, the container will not be picked up.

Health Physics must receive this form
by noon on Tuesday for pick-up on the following Wednesday morning.